NPIMap

Organization Active NPI

SSM Regional Health Services

Doing business as SSM Health Medical Group

  • Pulmonary Disease Physician
  • Jefferson City, MO
National Provider Identifier
1982137667
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
SSM REGIONAL HEALTH SERVICES
Doing business as
SSM Health Medical Group
Practice address
2505 Mission Dr Ste 130
Jefferson City, MO 65109-9508
Phone
(573) 681-3585
Fax
(573) 681-3665
NPI assigned
Apr 10, 2017
Last updated
Dec 16, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM REGIONAL HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shasta Rene Manuel
Title
Regional Vice President Finance/Cfo
Phone
(405) 272-7282

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

2505 Mission Dr Ste 130
Jefferson City, MO 65109-9508

Mailing address

7655 Solutions Ctr
Chicago, IL 60677-7006
Phone (557) 203-1551

Other names 1

  • SSM Health Medical Group Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL EPIC Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070213000635 MO Part B Supplier - Clinic/Group Practice 8921917352 Receives reassigned benefits from 64 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jefferson City, MO

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
SSM Regional Health Ser

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1982137667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7655 SOLUTIONS CTR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606777006",
            "telephone_number": "557-203-1551",
            "fax_number": "314-989-6721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 MISSION DR STE 130",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651099508",
            "telephone_number": "573-681-3585",
            "fax_number": "573-681-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM REGIONAL HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM REGIONAL HEALTH SERVICES",
        "enumeration_date": "2017-04-10",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "MANUEL",
        "authorized_official_first_name": "SHASTA",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "REGIONAL VICE PRESIDENT FINANCE/CFO",
        "authorized_official_telephone_number": "405-272-7282"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EPIC",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2505 Mission Dr Ste 130",
            "city": "Jefferson City",
            "state": "MO",
            "country_code": "US",
            "postal_code": "651099508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSM Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.